vancomycin

Clostridium difficile (C. diff) typical comes on after normal gut flora is destroyed or altered by antibiotics. It grows and multiplies – overpopulating the bacteria in your intestines. C. diff damages cells and mucosal, triggers inflammation, and forms a yellow plaque over the damage. Common symptoms are fever, cramps, abdominal pain, and uncontrollable diarrhea.

Since I didn’t have a job lined up upon college graduation, I moved 4 hours upstate with my parents. A few weeks after moving, I was admitted to the local hospital due to a UC flare, where they tested for C. diff among other typical labs. Since I got worse over the following days, they called my GI downstate and decided to retest for C. diff – which returned as “positive” meaning I likely became infected in the hospital. Since I hadn’t been on antibiotics in the last year, my doctors and I suspect it had something to do with how my body and my flora was reacting to Humira. Having Clostridium difficile colitis and an ulcerative colitis flare at the same time is the second worse pain I’ve experienced, just below the pain I experienced from drug-induced lupus on Remicade. During this week-long stay, I was hooked up to a pain pump with morphine and given steroids – too much at first, but I will cover that in another post. The doctors and nurses at this hospital worked with my care team downstate as I was not established with a specialist in the area yet.

At its worst, I was going to the bathroom 40 times a day. Most of the trips were between 3am and 8am – where I was running back and forth. This resulted in the second accident I had where I pooped on the floor on the way to the bathroom. Because I was embarrassed at the time and also knew how contagious C. diff is, I cleaned the mess up myself the best I could and hopped in the shower. In retrospect, I am not embarrassed and should have asked for help, but this was a low point for me at the time. Because of my frequent and numerous bathroom trips, I ended up losing 30 pounds within a week and a half and was extremely weak. They began me on IV vancomycin and discharged me with a prescription for Flagyl after a week because they weren’t able to do much more for me. I was told if things worsened when I got home, I should go to the larger hospital the next town over.

Later that day, things took a turn for the worse and I ended up in McLaren Hospital. The ER doctor who was assigned for my care was extremely rude and initially refused to treat me and admit me since I did not yet have a GI I was established with in the hospital system – even though I had just been in the hospital for a week and instructed to come there. This is the first time I had ever encountered this as I had always been assigned a specialist in the hospital if I didn’t yet have one. After some pushing, he ended up giving me IV fluids and potassium (since my levels were low) and then discharged me. If you’ve never had a potassium infusion before, you are very lucky. If it’s not mixed with enough saline, it can really burn. Since I was turned away at McLaren Petoskey, I returned to the smaller hospital and they continued to manage my pain and switched me from oral to IV Flagyl and potassium. They kept me for about another week and I also had a colonoscopy during this stay.

My GI downstate was still working with my doctors up north, but during my second week, he said he would no longer do this. I was told if I wanted him to still be part of my care, I would have to move back downstate. I was sent down with oral/liquid vancomycin and potassium powder mix, and I moved in with my grandparents. I was still up from 3am – 8am running to and from the bathroom every day. I remember watching The Night at the Museum (the original and Battle at the Smithsonian), Princess Diaries, and a lot of Ace of Cakes on repeat during these mornings as something to distract me from the pain. My grandparents ended up taking me back into the hospital after a few weeks, and I still tested positive for C. diff. I was admitted for just under a week. I was given IV Flagyl and had another colonoscopy. Though my C. diff wasn’t gone, I was starting to improve a bit and I headed back up north to my parent’s house.

When I returned to my parents, I became established with a GI out of McLaren hospital. A few weeks later, I went back in through McLaren’s ER. I had the same doctor as the first appointment, and he apologized for his behavior in my first appointment. He gave me IV fluids and potassium again, and they admitted me. During my stay, they set me up with an infectious disease doctor who did consults with me during this week-long stay, during which I did yet another round of IV vancomycin.

Once I was discharged, I saw the Infectious Disease doctor in her in the office to discuss the option of a fecal transplant and retest after Flagyl. I still tested positive so they had me continue Flagyl, and we got the ball rolling for the stool transplant. My cousin who lived nearby agreed to be the donor, and she had to go through multiple tests to rule out any diseases she may have that could be passed to me – HIV, hepatitis, infections, etc. Though the results had come back and she had been given the green light, there were roadblocks in getting the procedure scheduled. Because of this, I ended up back in McLaren hospital. I was admitted and my gastro came to see me. I asked for my infectious disease doctor to come do a consult as well, but she straight up refused. She finally agreed to talk to me on the phone and had the gall to tell me that since I had C. diff for almost four months, what’s the problem in continuing to treat the pain while waiting another two weeks for my transplant. Boy, did she hear it! It wasn’t as if I had been leaving it untreated or refusing care this whole time, but I had been in the hospital six times and on six rounds of antibiotics. This infection combined with my UC had left me with very minimal quality of life. After pushing, she was able to get me scheduled for the next week. They also let me stop taking the Flagyl that was making me feel sick, which I was thankful for since it wasn’t helping anyway.

Day of, I picked up my cousin’s sample and took the stool and the cheap blender I had purchased for the occasion and traveled to the hospital. A NG tube placed by radiology – this is the first time I had one. (A NG tube is through the nose then threaded down past your stomach to the beginning of your small intestine.) There was lots of gagging and dry heaving while they placed the tube. I threw up when they pushed the fecal transplant – I couldn’t taste it or anything. It was just the feeling of the push. The fecal transplant works by replacing the bacteria in your intestines with healthy flora. From the first day into the hospital to the date of my fecal transplant was exactly 4 months. I was thrilled that my C. diff cleared up completely within 48 hours after the fecal transplant. If I ever get antibiotic resistant C. diff in the future, I would definitely push for this earlier in the process.